Pre-policy medical tests: Key to transparent coverage & avoiding rejections

Imagine being denied health insurance coverage because of a medical condition you never knew existed, or worse, paying hefty premiums for years only to have your claim rejected due to a pre-existing condition. These scenarios, unfortunately common in India, highlight the complex debate surrounding pre-policy medical tests in health insurance.

 

While most health insurance providers do not mandate medical tests for policyholders before purchasing a policy, some may require one. Many individuals view these medical tests as inconvenient and prefer to avoid scheduling and undergoing multiple check-ups. As a result, many simply disclose any known pre-existing conditions to the insurer and obtain the policy. If there are no known medical issues, some individuals opt to get the policy without declaring any pre-existing diseases.

 

“While it may seem counterintuitive, undergoing medical tests before buying a health insurance policy can be a double-edged sword. On one hand, it promotes transparency and helps insurers tailor policies to your specific needs. This proactive approach can mitigate the risk of claim rejections and ensure a smoother claims process,” said Rakesh Jain, CEO, Reliance General Insurance.

 

“Medical tests promote transparency between insurers and policyholders, which is critical for smooth claim settlements. Taking this step not only secures appropriate coverage, but also enhances your confidence in the policy you choose, ensuring peace of mind during unforeseen medical situations,” said Gaurav Dubey, founder and CEO of Livlong 365.

  Benefits of undergoing medical tests

 

Accurate health assessment: Many individuals may be unaware of underlying health issues. A thorough medical examination can reveal conditions that require attention, allowing policyholders to address them proactively.

 

Potential premium discounts: Insurers often offer reduced premiums for applicants who pass their medical tests without any significant health concerns. This can lead to substantial savings over time.

 

Avoiding claim rejections: One of the most significant advantages of having a pre-policy medical check-up is the reduction in the likelihood of claim rejections due to undisclosed pre-existing conditions. If an illness arises that was not reported at the time of application, insurers may deny claims based on the argument that the condition existed prior to coverage.

 

Informed coverage decisions: Understanding one’s health status allows individuals to choose insurance plans that best suit their needs, ensuring adequate coverage for potential health issues down the line.

 

Who bears the cost of pre-policy medical checkups?

 

Typically, if the insurance company agrees to issue a policy, they cover the full cost of any pre-policy medical test. However, there are no universal guidelines regarding who is responsible for the cost if the individual is denied coverage after the medical examination.

 

In certain situations, the insurer and the individual may share the cost. In other cases, the insurer might charge the entire amount back to the policyholder or deduct it from any refundable amount.

 

“Health insurance safeguards against unforeseen medical expenses, not pre-existing conditions you’re already aware of. That said, it’s important to prioritise regular health check-ups or screenings every year. These proactive measures help you stay on top of your health, detect potential issues early, and make informed lifestyle choices— all of which align with maintaining long-term well-being. It’s always better to prioritise buying insurance early, ensuring you’re covered for unexpected health needs in the future,” Sushant Roy, co-founder, COO & CBO at Alyve health.